POS1198 VACCINATION AGAINST COVID-19 SHOULD BE ENCOURAGED IN PATIENTS WITH RHEUMATIC DISEASE, AS MOST PATIENTS DEVELOP A SEROLOGICAL RESPONSE AGAINST THE VACCINE AND VACCINATION REDUCES SELF-IMPOSED ISOLATION AND SHIELDING BEHAVIOR
Authors: C. Ammitzbøll, M. K. Thomsen, J. B. Andersen, L. E. Bartels, M. L. F. Hermansen, A. D. Johannesen, C. M. Jørgensen, S. Mikkelsen, S. R. Vils, C. Erikstrup, E. M. Hauge, A. Troldborg
Journal: Annals of the Rheumatic Diseases (2022)

Background Vaccine trials of the SARS-CoV-2 mRNA vaccines were encouraging but excluded most patients with rheumatic diseases (RD) and patients treated with immunosuppressive therapy. However, reports of a more severe COVID-19 disease course in patients with RDs prompted strategies for expediting vaccination of RD patients in most countries. In addition to the impact experienced by most people of the pandemic, patients with RDs were adversely impacted by the potential risk of severe COVID-19 due to their disease and immunosuppressive treatment. Fear of COVID-19 led to disproportionate anxiety, self-isolation, and shielding behavior for many RD patients at the beginning of the pandemic. Objectives We investigated antibody levels in serum against SARS-CoV-2 after a two-dose vaccination with an mRNA vaccine in patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). Further, we examined the association between reactogenicity and immunogenicity and how vaccination influenced patient behavior concerning fear of COVID-19 and shielding. Methods Patients with SLE or RA from the COPANARD (Corona PANdemic Autoimmune Rheumatic Disease) 1 cohort received two doses of an mRNA vaccine between January and August 2021 and had total antibodies against SARS-CoV-2 measured before vaccination and 2 and 9 weeks after the second vaccination. In addition, patients answered an electronic questionnaire before and eight weeks after vaccination concerning behavior, anxiety, and symptoms of depression (PHQ-9). Results Three-hundred-and-three patients and 44 blood donors (healthy controls) were included. Significantly fewer patients (90%) had measurable antibodies against SARS-CoV-2 compared to blood donors (100%) after the second vaccination (p&lt;0.001) (Figure 1). Treatment with Rituximab was the strongest predictor of unfavorable vaccine response, as only 27% were seropositive after vaccination. We found a negative effect of prednisone and methotrexate but no effect of age, comorbidity, or pausing medication on seroconversion. Patients experienced significant improvement after vaccination in 10 out of 12 questions regarding behavior and fear of COVID-19, but no change was observed in symptoms of depression (p=0.62) or anxiety (p=0.46). Figure 1. Total antibody response against SARS-CoV-2 after two mRNA vaccines . Antibody response against mRNA COVID-19 vaccine pre-vaccination, 1 and 9 weeks after in patients with rheumatic diseases and 5-6 weeks after vaccination in blood donors. (A) Percentage with measurable SARS-CoV-2 antibody results after vaccination. (B) Levels of SARS-CoV-2 antibodies in serum. Conclusion The majority of patients with SLE or RA had a measurable serological response to the COVID-19 mRNA vaccine after two doses. Treatment with Rituximab was the strongest predictor of no seroconversion. Our findings warrant encouragement of vaccination against COVID-19 for patients with RD, as most patients benefits with both a serological immune response and reduced isolation and shielding behavior. References [1]Ammitzbøll C, Andersen JB, Vils SR, Mistegaard CE, Mikkelsen S, Erikstrup C, Thomsen MK, Hauge EM, Troldborg A. Arthritis Care Res (Hoboken). 2021 May 31:10.1002/acr.24716. doi: 10.1002/acr.24716. Online ahead of print. Disclosure of Interests None declared